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Emergency department presentations in infants: Predictors from an Australian birth cohort
Julia Crilly1,2, Cate M Cameron1, Paul A Scuffham1
1Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia.
Insights
Maternal asthma and psychological distress predict infant emergency department (ED) visits. Screening mothers for distress during routine immunizations may reduce infant ED presentations.
Area of Science:
- Pediatrics
- Public Health
- Psychology
Background:
- Infants under 12 months are frequent emergency department (ED) users.
- Understanding predictors of infant ED visits is crucial for targeted interventions.
Purpose of the Study:
- To describe factors associated with ED presentations in infants.
- To identify psychosocial predictors of ED use in the first 12 months of life.
Main Methods:
- Prospective birth cohort study (Environments for Healthy Living).
- Analysis of baseline and 12-month questionnaire data from 2184 infants.
- Multiple regression analysis to identify predictors of ED presentation.
Main Results:
- 27% of infants presented to the ED within their first year.
- Maternal asthma (OR 1.67) and higher carer psychological distress (Kessler-6 score, OR 1.04) were significant predictors.
- Maternal education level was not associated with infant ED presentations.
Conclusions:
- Maternal and child factors, particularly related to the support system, predict infant ED visits.
- Screening mothers for psychological distress (e.g., using Kessler-6) during routine visits could be beneficial.
- Interventions addressing maternal psychosocial well-being may reduce infant ED use.
Aim:
Infants under 12 months of age are disproportionately represented amongst emergency department (ED) presentations, and infants are more likely to be frequent ED users. This study aimed to describe and identify psychosocial predictors of ED presentation in infants.
Methods:
A prospective birth cohort from Queensland and New South Wales (Environments for Healthy Living) was used to understand infant health service use. Baseline and 12-month questionnaire data pertaining to children born between 2006 and 2011 were used to identify predictors of ED presentation, using multiple regression analysis.
Results:
Of the 2184 children in the cohort with available baseline and 12-month data, 579 (27%) presented at least once to an ED during their first 12 months of life. Statistically significant predictors of ED presentation in the multivariate analysis included the mother having asthma (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.15-2.39) and a higher Kessler-6 score (a measure of psychological distress) of the primary carer at baseline (OR 1.04, 95% CI 1.01-1.08). Maternal education level was not associated with ED presentations of infants.
Conclusions:
This study describes maternal and child factors of children who present to the ED in the first year of life. Factors related to an infant's support system were found to be predictors for an ED presentation in the first year of life. This study emphasises the need to review the maternal medical history and psychosocial situation. There may be benefits for health-care practitioners to take the opportunity (such as during routine childhood immunisation) to perform a brief screening tool (such as the Kessler-6) to understand psychological distress experienced by mothers. This may influence the likelihood of a child presenting to an ED within the first 12 months of life.
